From the Guidelines
A recurrent tumor in cutaneous Squamous Cell Carcinoma (SCC) is defined as a locally recurrent tumor that arises either due to failure to treat the primary continuous body of tumor, or from local metastases, as noted in the multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma 1.
Definition and Diagnosis
The definition of a recurrent tumor in cutaneous SCC is crucial for determining the appropriate treatment approach. According to the guidelines, locally recurrent tumor may arise either due to failure to treat the primary continuous body of tumor, or from local metastases 1. This highlights the importance of complete removal or destruction of the primary tumor and any metastases to prevent recurrence.
Risk Factors and Treatment
Risk factors for recurrence in cutaneous SCC include tumor size, depth, poor differentiation, perineural invasion, location, immunosuppression, and incomplete initial excision. Recurrent cSCC is generally more aggressive than primary tumors and often requires more extensive treatment, including wide local excision with appropriate margins, Mohs micrographic surgery, radiation therapy, or in advanced cases, systemic therapy with immunotherapy or chemotherapy.
Surveillance and Follow-up
Close surveillance following initial treatment is essential for early detection of recurrence, typically involving skin examinations every 3-6 months for the first 2 years, then every 6-12 months thereafter. This allows for prompt identification and treatment of recurrent tumors, improving outcomes and reducing morbidity and mortality. The goal of treatment is complete removal or destruction of the primary tumor and any metastases, with histological assessment being the gold standard for identification of tumor margins 1.
From the Research
Definition of Recurrent Tumor in Cutaneous Squamous Cell Carcinoma (SCC)
- A recurrent tumor in cutaneous Squamous Cell Carcinoma (SCC) refers to the reappearance of cancer after treatment, which can occur locally or regionally 2, 3.
- Recurrent cSCC has been associated with an increased risk of local functional and aesthetic comorbidity, metastasis, and mortality 2.
- The risk of recurrence can be influenced by various factors, including tumor size, depth of invasion, histological differentiation, site of the lesion, perineural and intravascular invasion, positive lymphadenopathy, immunosuppression, and history of treatment 3.
Characteristics of Recurrent Tumors
- Recurrent tumors can occur at the same site as the original tumor or in nearby tissues 4, 3.
- The median time to recurrence can range from 1 to 81 months, with a mean follow-up of 32 months 3.
- Recurrent tumors can be more aggressive and have a higher risk of metastasis, which can lead to poor overall survival 5.
Treatment and Outcomes
- Treatment modalities, such as surgery, radiation therapy, and immunotherapy, can be used to manage recurrent cSCC 6, 5.
- The outcomes of recurrent cSCC can vary depending on the stage, treatment, and presence of prognostic indicators, such as parotid involvement, positive margins, and distant metastasis 5.
- Adjuvant postoperative radiotherapy may not improve overall survival in patients with advanced recurrent cSCC 5.